796 



THE VASCULAR SYSTEMS 



the right portion of the greater curvature and end in the right gastroepiploic 

 nodes, the efferents of which pass to the subpyloric group. Those of the fourth 

 set drain the pyloric canal and pass to the hepatic and subpyloric nodes, and, 

 in part, also to the coronary chain. 



CORONARY 

 CURRENT 



RIGHT 



GASTRO-EPIPLOIC 

 CURRENT 



FIG. 571. Lymphatic areas of the stomach. (Cuneo.) 



Applied Anatomy. Mikulicz pointed out the early infection of the nodes of the lesser curva- 

 ture in pyloric cancer, and insisted that in operation for pyloric cancer the entire lesser curvature 

 must be removed. Cuneo showed that in pyloric cancer the fundus and two-thirds of the 

 greater curvature usually remain free from disease, because the lymph current is toward the 

 pylorus and not from it. Of course, if the lymphatics become blocked, the lymph current may 

 be reversed (regurgitation), and then infection of these parts can occur. William J. Mayo has 

 noted the "lymphatic isolation" of the dome of the stomach. In operating for cancer of the 

 pylorus, make the section of the stomach as directed by Hartmann, that is, a section which 

 removes all of the lesser curvature and cuts the greater curvature well to the left of the subpyloric 

 nodes. 



FIG. 572. Lymphatics of the small intestine. (Poirier and Charpy.) 



The lymphatic vessels of the duodenum consist of an anterior and a pos- 

 terior set which open into a series of small pancreaticoduodenal nodes on the 

 anterior and posterior aspects of the groove between the head of the pancreas 

 and the duodenum. The efferents from these nodes run in two directions, 

 upward to the hepatic nodes and downward to the preaortic nodes around the 

 origin of the superior mesenteric artery. 



